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THREE-MONTH DOC FIX COULD BE ADDED TO BUDGET DEAL— A three-month patch to prevent the impending cut in physician payments could be added to the budget deal reached Tuesday evening. The bill, which funds a 0.5 percent increase to physicians, was posted to the House Rules Committee very early this morning as a pending amendment to the budget legislation. It includes some extenders. The patch is funded by a long-term extension of cuts in Medicaid DSH payments and in patient services in long-term care hospitals. The bill also delays the implementation of the new "two midnight" rule for hospitals. In a nod to the ongoing permanent repeal effort, its called the "Pathway for SGR Reform Act of 2013." The bill http://1.usa.gov/IEBVuh

ENROLLMENT NUMBERS ON THE WAY — As the Obama administration prepares to release the November enrollment stats this morning, there’s lots of doubt about whether it will manage to register 7 million people in exchanges by the end of March, which was the original goal. Now officials are trying to downplay that number as Republicans hold it up as the latest example of why Obamacare is failing. “Even though they adopted the estimate as a marker for people grasp the scale of the task in the first year and beyond, White House officials said it shouldn’t be viewed as the definitive benchmark for success,” Carrie Budoff Brown and Jason Millman write. http://politi.co/1d7XnRw

SEBELIUS RETURNS TO THE HILL — It’s been more than a month since HHS Secretary Kathleen Sebelius last testified before Congress, so she’s probably thrilled to return. She’ll sit before the House Energy and Commerce Health Subcommittee this morning for her third Obamacare grilling. Republicans plan to probe her on how much the administration spent on the insurance exchanges and who made key decisions about the website’s functionality. They also want details about the administration’s work with HealthCare.gov contractors. A list of their planned questions: http://1.usa.gov/1jKVejU And her prepared remarks: http://1.usa.gov/JbYabx

—Sebelius doesn’t seem to be getting a lot of visible support from the White House, POLITICO’s David Nather writes. She escaped some scattered calls for her resignation, but the rest of the administration isn’t exactly pulling out all the stops to defend her work. That puts her in the position of taking the hits for the bungled rollout without getting a lot of confidence-bolstering White House support in return. Awkward. http://politi.co/1goQPDg Watch the hearing here at 10:00 a.m.: http://1.usa.gov/1gnpjGi

—Gary Cohen, director of the Center for Consumer Information and Insurance Oversight at CMS, will also testify today, appearing before the House Small Business Committee at 1:00 p.m. to talk about the small business SHOP exchanges.

Welcome to Wednesday PULSE, where we’re pretty happy that it’s Christmas movie time on TV and wondering if we’re the only 29-year-old who just watched “Home Alone” for the first time ever. We’re also betting that more people enrolled in Obamacare in November than follow us on Twitter. You can help change that: @pw_cunningham.

“But with you, I PULSE again.”

FIRST IN PULSE: SGR BILL TO INCLUDE MENTAL HEALTH — PULSE has learned that lawmakers will vote on adding a mental health provision onto the SGR replacement plan being considered by Senate Finance tomorrow morning. A scaled-back version of Sen. Debbie Stabenow’s Excellence in Mental Health Act, it would establish a 10-state demonstration program where states would certify that community mental health providers meet new standards of care and offer a broader range of services, like 24-hour crisis psychiatric services. The new services could be reimbursed under Medicaid, costing an estimated $1.6 billion over 10 years. More details: http://politico.pro/18Ao0fk

GROUPS WEIGH IN ON SGR — Our inbox was sort of flooded today with groups responding to the SGR bill. Most groups are pretty pleased about it, although they’d like it to include more payment updates. The American Medical Association wrote to lawmakers yesterday to express their support. So did the American Osteopathic Association, American Academy of Family Physicians and American College of Physicians. Their letter: http://politico.pro/1aT3VR7 And the AMA letter: http://politico.pro/1f5oPku

—But not everyone is tickled pink. Surgeons said the proposal would pit doctors against each other for payments, since the pool of quality-based payments is capped. They’re also not pleased that it freezes payment rates for 10 years. The plan “will hinder our members’ ability to keep their practices open, disincentivize the sharing of best practices and place patients’ access to surgical services as risk,” the American College of Surgeons and 15 other surgical societies wrote to lawmakers.

—Both the House and Senate SGR markups will be held at 10:00 a.m. on Thursday.

STATE EXCHANGES BAN ABORTION COVERAGE — Remember that fight about federal funding for abortion that nearly derailed the Affordable Care Act back in 2010? It was resolved (sort of) by requiring women to pay a separate, subsidy-free premium for abortion coverage. But four years later, nearly half the states have banned coverage, period. This week, Michigan could become the 24th. Many of the bans include exceptions in cases of rape, incest and life of the mother but otherwise prevent plans from including abortion in their list of covered services. http://politi.co/18lTj2u

VITTER REJECTS HEALTH CONTRIBUTION — This really shouldn’t surprise anyone — Sen. David Vitter (R-La.) has officially foregone the federal government’s contribution to his health care plan and signed up in his home-state exchange instead of in D.C. He joins a growing list of lawmakers who have declined their contribution. http://politi.co/1bvD5i1

—Sen. Marco Rubio chose a different route, signing up himself and his family for coverage in the D.C. exchange and accepting the federal employer contribution, which covers up to 75 percent of the premium costs, the Tampa Bay Times reports. http://bit.ly/1d7jg3l

** A message from AHCA. As Congress mulls options to pay for the doc fix this year, skilled nursing and assisted living providers have smart policy alternatives that lower Medicare costs without cuts. We are AHCA. And we are the solution. Learn more at http://ahcancal.org/solutions. **

BUDGET RELEASED — Rep. Paul Ryan and Sen. Patty Murray unveiled their two-year budget agreement Tuesday night, and as expected, it doesn’t include any entitlement reforms or much else in the way of health care policy. It does however include a provision allowing states to delay paying for certain Medicaid claims, lets them collect medical child support in certain cases and lets Medicaid recuperate costs from beneficiary-liability settlements, as part of a several measures aimed at fraud and abuse. A summary: http://1.usa.gov/1fi0LeV And the POLITICO story: http://politi.co/1aT79nI

SPANISH ENROLLMENT HERE — Better tarde than never. Enrollment tools on the Spanish-language version of HealthCare.gov are finally available, after repeated delays by the Obama administration. Check it out: http://1.usa.gov/1dnKIKo

MEDICAID, IT’S A BREEZE — Thanks to personal information provided by benefits like food stamp programs, states are finding it pretty easy to sign up people for Medicaid. In Oregon, Medicaid signups have been the lone bright spot as the state’s exchange website has failed to sign up a single person. Arkansas has also leveraged the Supplemental Nutrition Assistance Program to sign people up. About 223,000 people have signed up for Medicaid through the SNAP, a CMS report said last week. For Pros: http://politico.pro/18B9oiT

—We’d note that even though Oregon hasn’t signed up anyone for the exchanges online, its “fast track” process for Medicaid enrollments has signed up more than 90,000 so far. And new figures reported by Cover Oregon yesterday show that the exchange, which is using paper applications, has so far signed up about 9,200 people for Medicaid coverage and 730 in private plans.

DIRECT ENROLLMENT, NOT SO MUCH — Insurers have been pushing since October to be able to directly enroll people who qualify for insurance subsidies, but the computer system is beset with enough ongoing problems that they’re steering clear for now, Pro’s Brett Norman reports. “The system is working at this point but not particularly well,” he writes. “And because of its issues, it’s not being used widely enough to be of help to many people. Some insurers are expanding their use of direct enrollment, but others still say it’s too unreliable.” http://politico.pro/1buzgtu

MARK YOUR CALENDAR for two POLITICO Pro events this week. Join us Thursday for a look at preparations for the January 2014 Medicaid expansion. On Friday we’ll tackle bundling. Both discussions begin at 8 a.m.; Thursday at the Mayflower Hotel and Friday at the Capitol Hill Hyatt. Sign up for Pro Health Care: Medicaid Expansion here: http://politi.co/1gX2cjr And Pro Deep Dive: Bundling of Care: http://bit.ly/1e3tTcB

MENTAL HEALTH IN VIRGINIA — The state’s seen plenty of tragedies involving mental illness — the 2007 Virginia Tech massacre and, most recently, the suicide of former state Sen. Creigh Deeds’ son. Virginia Gov. Bob McDonnell said yesterday that he wants to spend $38.3 million in the next two-year budget cycle to improve mental health services. He also ordered the creation of a new mental health task force. http://politico.pro/1buoEec

TOP 2014 HEALTH CARE ISSUES — PwC has released its annual list of the ten top issues facing the U.S. health industry. Topping the list is price transparency. Other top issues include the new small business insurance exchanges, new regulations aimed at counterfeit drugs and states’ managed care approaches to contain Medicaid costs. The report: http://politico.pro/18T0aks

HEALTH CARE PRICES IN OCTOBER rose just 0.9 percent above prices in October 2012 — the smallest month-on-month increase in more than 50 years, according to the Altarum Institute. Their report also finds that national health expenditures grew 4.1 percent between the two months but the rate of growth over the year’s first 10 months remains relatively low. And the industry added 28,400 jobs in November, more than the 24-month average of 22,800. The report: http://bit.ly/1buwRPk

CFPB ORDERS REFUND OVER MEDICAL DEBT — A subsidiary of GE Capital was apparently using deceptive tactics to convince people to sign up for credit cards to cover the cost of medical procedures, so the Consumer Financial Protection Bureau has ordered it to refund consumers $34.1 million. The cards — which face growing scrutiny from state and federal officials, are often sold by doctors, dentists and their office staff who offer it as a payment option for a patient. http://politico.pro/1iUx0pc

WHAT WE’RE READING, By Natalie Villacorta

A New York Times/CBS News poll suggests that for President Barack Obama the political fallout from HealthCare.gov's messy rollout might be over, but his health care law remains very unpopular: http://nyti.ms/JdcErN

** The skilled nursing and assisted living profession has some smart solutions to reduce spending without across-the-board cuts to Medicare providers. Our plan to reduce hospital readmissions and thereby improve patient outcomes would produce $2 billion in Medicare savings by 2022. That measure goes beyond what other proposals offer by including every classification of readmissions, providing Congress a more comprehensive view of hospital readmissions and their financial impact on the Medicare program. But this plan is just the beginning. We are AHCA and NCAL. And we are the solution. Learn more at http://ahcancal.org/solutions. **